Hilar Cholangiocarcinoma: Resection or Transplantation?

AbstractPurpose of ReviewThis is a review of the current status of surgical resection and liver transplantation in the treatment of hilar cholangiocarcinoma (CCA).Recent FindingsFor patients with hilar CCA and underlying parenchymal disease, specifically those with primary sclerosing cholangitis, liver transplantation is generally favored as there is risk of hepatic insufficiency and multicentric disease with extended resection. For de novo patients with no underlying liver disease, the decision between resection and transplantation proves to be more difficult. Results have shown that when margin- and node-negative resections are achieved, survival outcomes between patients undergoing resection and liver transplantation are comparable, though at baseline the patients selected for transplant were unresectable and, thus, had no other curative option and potentially more advanced disease than those selected for resection. Difficulty lies, however, in accurately predicting which patients are resectable as commitment to surgical resection precludes liver transplantation and vice versa. Recent work has focused on improving surgical resection outcomes as liver transplantation continues to be limited by the extreme organ shortage. Hilar lesions previously considered unresectable as a result of vascular involvement are now being resected using en bloc surgical techniques with vascular reconstruction. Additionally, the application of portal vein embolization to CCA has allowed for safe...

Source: Current Surgery Reports - February 12, 2017 Category: Surgery Source Type: research